Case 195: Manual of PCI - Physiology-guided PCI

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A patient was referred for PCI due to medically refractory angina. He had a severe, Medina 0.1.1 bifurcation lesion in the distal RCA at the PDA bifurcation and an eccentric lesion in the proximal/mid RCA. Wiring of the distal RCA lesion failed using workhorse wires but succeeded using a Sion black wire. After predilatation, provisional stenting was done from the distal RCA to the right posterolateral, which “pinched” the PDA ostium. The PDA was rewired followed by kissing balloon inflations with a 2.0 and 2.5 mm Scoreflex balloons in the PDA that provided a nice final result in the PDA without translesional pressure drop. A drug-coated balloon was used in the PDA to minimize the risk of restenosis. Pressure wire pullback showed a discrete large pressure gradient in the proximal/mid RCA that resolved after stenting of the proximal/mid RCA lesion.
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Cardiology
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